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    Jenni Bertels   
503-947-7742   

Electronic Data Interchange (EDI)



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EDI Medical Bill Reporting:
 
  Send us an email about EDI Medical Bill Reporting questions
     
  Medical EDI Traffic Report
 
  To obtain Expanded List of Valid Revenue Codes (NUBC webpage)
     
  List of insurers and self-insured employers required to report medical bill data (now Bulletin 359)
     
  List of taxonomy codes that do not require a diagnosis code
 
  Frequently asked questions for EDI medical bill reporting
 
  Rules affecting EDI medical bill reporting - OAR 436-160
       
  Medical Bill Data Element Requirement Table
     
  DN Error Message Table: (PDF) | (Excel)
 
  EDI Medical Billing Trading Partner Profile Form: Trading Partner Profile (Form 4015)
 
  Oregon Data Elements by Source table
 
  Obtain IAIABC EDI Medical Implementation Guide
     
  Release 2 Transition FAQs and Updates
  Transition to ICD-10 Codes (Information)
  Oregon critical access hospitals are not required to report the MS-DRG codes on their inpatient bills. [Most Oregon hospitals are required to report the appropriate MS-DRG codes on their workers' compensation inpatient hospital bills. (4/1/11)]
    The list of required Oregon hospitals can be found in Oregon Administrative Rule 436-009, Appendix A.
 

EDI Proof of Coverage Reporting:
  Division 162 Electronic Data Interchange; Proof of Coverage Rules
  Oregon EDI Implementation Guide for Proof of Coverage - December, 2010
  Proof of Coverage-Edit matrix
  Trading Partner Agreement, (Filing Guaranty Contracts), Form 4820; for information contact:
      EDI Coordinator: 503-947-7742; Email: edinews.wcd@state.or.us
  Oregon Proof of Coverage EDI Insurer Profile Form 4821
  Insurer registration requirements
  Employee Leasing Policy Identification
  Proof of Coverage Revised Element Requirement Table shows what data WCD requires the insurer to submit for various types of coverage filings. Note that more data is required for Establishing Document-type transactions than for other types of filings. This is because, once the insurer has submitted data to WCD they don’t need to send it again unless it changes. We will “link” the new data to what was originally reported by using a combination of the Policy Number, policy dates, and the Federal Employer Identification Numbers (FEINs) for Insurer, Insured, and Employer.

Data elements are either (M)andatory, (C)onditional, or (O)ptional. A mandatory data element must be submitted and must be valid. A conditional data element must be submitted if another data element value requires it; for example, if this is a rewrite or reissue of a previously submitted policy, the insurer must send the prior policy number so we can link the two policies. An optional data element is one that we want the insurer to send if they have it, but we won’t reject a transaction if it’s not included. Items such as the Business Identification Number (BIN/UI) are optional, because not every employer is required to have a BIN.
  If we receive an EDI transaction with a mandatory piece of data that is missing or invalid (like a date of 00/00/00), we will reject the transaction. That means the insurer has not filed the report with us and may be subject to fines if they don’t correct the mistake and report the data again, within the required time limits. See Proof of Coverage Revised Edit Matrix below.
  Proof of Coverage Revised Edit Matrix shows what numeric error codes an insurer will receive if we find something wrong with the coverage data they have submitted electronically. The Acknowledgement that we send back after every EDI transaction will have a list of which records (all the information about a new policy, an endorsement, a cancellation, or a reinstatement) were accepted and which were rejected. The individual data elements that have errors will be identified, and one or more of these error codes will be listed. That way, the insurer will know which piece of data on which transaction is wrong. In the case of a rejected transaction, the insurer will correct the data and send it back to meet filing requirements.
 
eBilling for Workers' Compensation
  Ebilling rules, companion guide, resources, and more
 

Other resources:
 

HIPAA

 

International Association of Industrial Accident Boards and Commissions (IAIABC)

 

National Council on Compensation Insurance

 

Insurance Services Office



If you have questions about this webpage, please contact Jenni Bertels, 503-947-7742.